Current through Register Vol. 60, No. 12, December 1, 2021
the event of a finding of MCE impairment by the Authority, or of a termination
of the MCE contract, members of the MCE shall be offered disenrollment from the
MCE and enrollment in accordance with the Authority's rules.
(2) For the purpose of this section only, and
only in the event of a finding of MCE impairment by the Authority or of a
termination of the MCE contract, any covered health care service furnished
within the state by a provider to a member of the impaired or terminated MCE
shall be considered to have been furnished pursuant to a contract between the
provider and the MCE with whom the member was enrolled when the services were
(3) Each contract
between an MCE and a provider of health services shall provide that if the MCE
fails to pay for covered health services as set forth in the contract, the
member is not liable to the provider for any amounts owed by the MCE.
(4) If the contract between the contracting
provider and the MCE has not been reduced to writing or fails to contain the
provisions required by this rule, the member is not liable to the contracting
provider for any amounts owed by the MCE.
(5) No contracting provider or agent, trustee
or assignee of the contracting provider shall bill a member, send a member's
bill to a Collection Agency, or maintain a civil action against a member to
collect any amounts owed by the MCE for which the member is not liable to the
contracting provider in this rule and under 410-120-1280.
Nothing in this section impairs the right
of a provider to charge, collect from, and attempt to collect from or maintain
a civil action against a member for any of the following:
(a) Health services not covered by the MCE,
if a valid OHP Client Agreement to Pay for Health Services form OHP 3165, or
facsimile, signed by the client, has been completed as described in OAR
services rendered after the termination of the contract between the MCE and the
provider, unless the health services were rendered during the confinement in an
inpatient facility and the confinement began prior to the date of termination
or unless the provider has assumed post-termination treatment obligations under
the contract. Before providing a non-covered service, the provider must
complete an OHP 3165, or facsimile, as described in OAR 410-120-1280.